• Hirofumi Kawanaka, Shoji Hiroshige, Nobuhide Kubo, Teijiro Hirashita, Takeshi Masuda, Yushi Kaisyakuji, Hirotada Tajiri, Akinori Egashira, Toshifumi Matsumoto, and Tokujiro Yano.
• Clinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical Center, Beppu, Japan. Electronic address: harrykw@v102.vaio.ne.jp.
• J. Am. Coll. Surg. 2018 May 1; 226 (5): 891-901.

BackgroundObturator hernia (OH) is a rare but serious disease associated with high morbidity and mortality due to advanced patient age and comorbidities. This study evaluated the feasibility of a laparoscopic approach to OH.Study DesignWe retrospectively reviewed the records of 32 patients (median age 84 years; 31 women) with OH treated between 2003 and 2016.ResultsFive patients with incidental OH underwent total extraperitoneal (TEP) repair. Of 27 patients with incarcerated OH, 18 patients underwent laparotomy, 13 of which required bowel resection, and the remaining 9 patients underwent preoperative ultrasound-guided manual OH reduction. Of 6 patients with successful OH release, 3 and 2 patients underwent TEP and transabdominal preperitoneal repair, respectively, and 1 patient declined the operation. Three patients with failure underwent laparoscopic exploration and conversion to open operation for bowel resection. Comparing the open and laparoscopic groups, the median operation times were 67.5 minutes vs 124 minutes, respectively (p = 0.004); median postoperative stay was 19 vs 11 days, respectively (p = 0.028); and Clavien-Dindo grade II or higher complications tended to be lower (28% vs 8%, respectively; p = 0.359). Even in patients without bowel resection, the median postoperative stay was significantly shorter in the laparoscopic group compared with the open group (7.5 vs 15 days, respectively; p = 0.032). During a mean follow-up of 24.5 months, the 3-year recurrence rate for OH was 25% for non-mesh repair and 0% for mesh repair (p = 0.335). Three- and 5-year cumulative survival rates were 83% and 71%, respectively.ConclusionsLaparoscopic operations after ultrasound-guided manual reduction can be an alternative to emergent laparotomy in select OH patients.Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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